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From Pilot to Process Implementing Blockchain into the
Episode and Economics of Care - Part 1
Session 4, Blockchain Symposium
Jim St.Clair, CTO, The Dinocrates Group LLC (Moderator)
Robert Miller, CEO, Honeycomb Health
Rishi Madhok, MD, Chief Executive Officer, BitMED
James Zadoorian, PhD, Managing Principal, ArxChange
Organization logo(s) may be placed on this slide
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Neither the Moderator nor panelists have real or apparent conflicts
of interest to report.
Conflict of Interest
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Robert Miller, BA
Salary: Consultant for non-profit Greater Good
Consulting Fees (e.g., advisory boards):
PhUSE Blockchain in Healthcare Working Group
IEEE Blockchain in Healthcare Standards Development Working
Group
Blockchain in Healthcare Global Member
Ownership Interest (stocks, stock options or other ownership
interest excluding diversified mutual funds): Own stock in
Honeycomb Health and RemediChain. Also a board member of
RemediChain.
Other: I also own BTC and ETH.
Conflict of Interest
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While there is no shortage of blockchain use cases for healthcare,
working applications, pilots and deployments are still hard to find.
This session look past whitepapers to projects that are actively
being piloted or deployed - real word use cases.
To truly fulfill the idea of blockchain as a force for change, we
need to see solutions that could not have exist in a world without
it.
This session will give the stage to companies who have embraced
this new technology and are using it to change a broken system.
Agenda
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Outline a systemic healthcare problem and present a new solution
Discuss why blockchain is core to the solution
Provide an overview of a future state and how things will be
different with widespread adoption
Outline some of the design/platform decisions made and
challenges overcome
Learning Objectives
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Robert Miller, CEO & Co-Founder, Honeycomb Health
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What are tokens?
Tokens are digital assets created on top of a
blockchain. These take two primary forms:
Currencies
Digital goods
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Non-unique, currency-like digital assets that are
interchangeable.
Most “Healthcare tokens” or “healthcare
cryptocurrencies” are ERC20 tokens.
Different models for how these are used. Most common
overall and within healthcare is the payment token, a
currency used only to pay for goods or services within a
closed ecosystem.
Currency tokens (“Fungible”)
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Digital goods tokens
(“Non-Fungible” or NFTs)
Technical standard: ERC721
Unique, one of a kind digital
assets with attributes. These are
not interchangeable.
First use cases were for trading
card like games.
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Anatomy of a NFT
DNA / Attributes
Category 1: 2
Category 2: 128
Category 3: 8
Category 4: 92
.
.
.
Owner: 0xf7Ac9D59…
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Anatomy of a NFT - healthcare
Attributes
good_id: 0x121f..
batch: 0x0fnw2…
dispatch: 1293…
prod: 0x321zq…
quantity: 128
Last_owner: Manufacturer
.
.
.
Owner: Supplier
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Anatomy of a NFT - healthcare
Attributes
Issued by: NYU
Degree: Doctor of Medicine
Practice: NY
Date: 1/16/2019
Signed by: 0x1y8i100….
Owner: Physician
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Currency tokens were the first
wave of healthcare tokenization
~200 attempted healthcare tokens from 2016 -
2018.
~$500,000,000 dollars were raised through
Initial Coin Offerings (ICOs)!
Data suggests that almost all healthcare tokens
are built on Ethereum
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… but these didn’t turn out so good
Project
Listing date
Raised Listing price Price 1/16/19 Returns %
Medicalchain
2/6/18
$24,000,000.00
$0.32
$0.005
-
98.54%
AIdoc
1/10/18
N/A
$0.23
$0.004
-
98.29%
Patientory
6/6/17
$23,000,000.00
$0.65
$0.015
-
97.7%
Shivom
6/7/18
$35,000,000.00
$0.05
$0.001
-
97.2%
Curecoin
5/26/14
$6,800,000.00
$0.80
$0.05
-
93%
Medibloc
12/22/17
$6,000,000.00
$0.02
$0.00
-
89%
Medishares
12/13/17
N/A
$0.03
$0.01
-
76%
Nam
-coin
8/4/18
N/A
$0.0004
$0.0001
-
74%
Docademic
10/1/18
$1,100,000.00
$0.05
$0.01
-
72%
Lympo
3/1/18
$14,000,000.00
$0.02
$0.01
-
66%
Ambrosus
10/23/17
$32,000,000.00
$0.20
$0.08
-
62%
Farmatrust
8/14/18
$7,000,000.00
$0.01
$0.00
-
61%
Dentacoin
8/11/17
$3,000,000.00
$0.0003
$0.0001
-
52%
Modum
10/23/17
$13,400,000.00
$0.49
$0.30
-
38%
Timicoin
8/30/18
$20,000,000.00
$0.06
$0.05
-
23%
Encrypgen
11/20/17
$1,000,000.00
$0.05
$0.04
-
16%
At their peak the market capitalization for healthcare
tokens was briefly $3.5bn. It now rests around
$100m.
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The next generation will be driven
by mechanism design
Game theory explores outcomes derived
from a set of rules.
Mechanism design is engineering the
rules to achieve a desired outcome.
Have pre-defined
rules?
Have a desired
outcome but no
rules?
Game
theory
Mechanism
design
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Token economics
Using mechanism design within token
economies to achieve desired outcomes.
The tools we have at our disposal make this an
incredibly exciting field.
Staking Slashing Governing
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Emerging token tools
Staking
Users receive a benefit for locking up their tokens
for a period of time
Example: users could lock up 100 tele-credits for a
month to get a 10% discount on a telemedicine
consultation.
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Emerging token tools
Slashing
Users lock up their tokens for a period of time and
they are confiscated if they act dishonestly.
Example: users pay an “application fee” to be
verified as phyiscians on a decentralized registry. If
their applications are denied their application fee is
not returned.
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Emerging token tools
Governing
Tokens grant the users the right to initiate and vote
on proposals that affect the network.
Example: A network of providers using the same
EHR could adopt changes in their data standard by
voting with tokens. Votes would be weighted by
how many tokens they have.
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2
nd
wave of tokens: decentralized
registry of physicians
Uses token economics to incentivize actors to honestly
curate a list of verified physicians on chain.
Primarily uses slashing as a way of keeping
applicants honest.
These are called Token Curated Registries (TCRs)
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2
nd
wave of tokens: healthcare
services as digital goods
Attributes
Redeemable for: 1 MRI
Issued by: community provider
Expires: 12/31/2019
Network: generic network
Transfers: restricted
Providers can issue digital goods which represent
discrete healthcare services. These can then be bought, sold,
and tracked on marketplaces.
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Take aways
The first wave of tokenization was in currencies, the
second wave will be digital goods in the form of NFTs
Token economics is a real, emerging field but we are still
figuring out how to create sustainable value
Enterprises should be focused on tokenization in the form
of digital goods
Look for use cases where identity, scarcity, and value
are important
The most valuable use cases will be those that involve
a network
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Thank you!
bertcmiller
rmiller@honeycombhealth.com
bertcmiller
Blockchain & healthcare newsletter
www.bertcmiller.com/himss
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Rishi Madhok, MD, Chief Executive Officer, BitMED
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James A. Zadoorian, Ph.D. Managing Principal, ARxChange
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For there to be a sustainable blockchain-based
economy of any sorts, there needs to be
sustainable economic activity
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Inside the numbers
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Inside the behavior
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Inside the “game”
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Inside the “moves”
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Inside the payment decision
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Inside the solution: intelligent price design
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Future-state architecture?
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Future-state stability
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Questions?